Increasing advances in the field of transfusion medicine and technology have necessitated enforcing measures to ensure the quality of blood and its products. Dr Ramona Chopra, Regional Director, India and APAC, Immuco reveals more
Medical science has made immense progress over the past decade, and it would not be wrong to say that
transfusion medicine has emerged as the backbone of hospitals to support surgeries, transplants, trauma patients, routine transfusion support in dialysis, cancer patients and thalassemia etc.
A blood bank is now rightfully given the title of ‘Department of Transfusion Medicine’ as it is much beyond the only collection, storage and issue of blood. Transfusion medicine is a well-known field of medicine today with
departments run by professionally qualified specialists and trained technologists. The great journey started in 1665, with the first canine transfusion by the Royal Society of London. The first animal to human transfusion was performed in 1667, and human to human in 1818. The veritable breakthrough came in the 1900s, with the discovery of the ABO blood group system by Kal Landsteiner. In recognition, Landsteiner was awarded the Nobel Prize for his revolutionary discovery in 1930.
Further investigations and discoveries have led to advancements in the field, and to date, there are 38 recognised blood group systems. The transfusion medicine department is segmented into different sections:
starting with donor screening/counselling area, phlebotomy area, blood component preparation and storage area, Apheresis section, TTI (Transfusion Transmitted Infections) area, Serology/IH (Immuno Haematology) testing area and finally issue counter. Many advancements have been made in every section of the department starting from the donor screening area, where a person is assessed against various health and physical parameters to qualify them as a donor. The phlebotomy area now has scientifically designed donor couches for correct position and comfort, blood collection monitors to weigh the blood bag and automatically stop the donation once the required volume is reached. The blood bags themselves that are used today, come with integrated inline filters to remove leukocytes. The concept of whole blood has given way to blood components. Most centres now use automated component extractors to divide a unit of whole blood into packed red cells, plasma and platelets. The newer concept of platelet pooling is also coming up at various centres to better manage the availability of platelets. The storage section is continuously monitored for any temperature
variations to ensure blood quality.
For better inventory management and ensuring the right blood to the right patient, RFID tags are now becoming
the next tool to ensure safe transfusion. Plasmapheresis and therapeutic plasma exchanges have become common in multispecialty centres and with these transfusions, medicine specialists are providing the much-needed support to organ transplant patients as well. In the segment of safe blood transfusion, TTI& IH testing are critical areas. As per guidelines, all the collected units are screened for HIV, HBsAg, syphilis, HCV and malaria. Early tests for these markers used ELISA techniques, however, now technologies like Chemiluminescence & Nucleic Acid testing (NAT) are preferred.
The IH testing journey, which started with only forward blood grouping and crossmatching by tile/slide method,
moved on to test tube and has now moved to more advanced technologies like Column Agglutination and Solid Phase Red Cell Adherence for specialised tests like antibody screening, phenotyping, antibody identification, weak D, titres, platelet crossmatching etc., to make transfusion safer for patients. These technologies lend themselves to automation, resulting in better throughput, turnaround time, improved documentation and traceability of the tests performed. Clinicians are more aware and follow International Global guidelines having realised theimportance of pre-transfusion testing with an emphasis on antibody screening and identification. If an antibody screen is positive, providing antigen-negative red cell units leads to better red cell survival. When it comes to guidelines for IH testing, India still lags behind developed nations. Although there are guidelines set by authorities, the majority of departments either do not have the resources or the budget and hence, do basic minimum pre-transfusion testing.
Increasing advances in the field of transfusion medicine and technology have necessitated enforcing measures
to ensure the quality of blood and its products. In India, blood and its products are classified as drugs and thus blood banks are regulated by drug control authorities. Detailed guidelines issued by NACO cover all aspects of the blood bank. National Accreditation Board for Healthcare Providers (NABH) provides Accreditation Standards for Blood Centres/ Transfusion Services. To date, there are 1051 blood banks which are NABH accredited. The National Institute of Biologicals (NIB) also has a Haemovigilance program to collect and assess information on unexpected or undesirable effects resulting from the therapeutic use of blood products.
It is now time to raise the importance of reporting IH events and align with the focus on TTI. The annual Serious
Hazards of Transfusion (SHOT) reports from the UK, show the importance of Haemovigilance. Haemovigilance reporting and learning from reports submitted contribute to improving patient safety. These reports provide a mechanism to identify risks so that all healthcare organisations can implement interventions to reduce these risks.
Data from SHOT provides valuable information to identify hazards and worthwhile learning opportunities.
Transfusion medicine in India today is fast closing the gap with its western counterparts as the same instruments and technologies are available in India. Although most of these new technologies are implemented in major transfusion centres of Class A cities, there is still a need to uniformly make these available in all parts of the
country, so that patients in remote parts may also benefit from recent advances in this field. The real journey has started in the last few years, however, patient safety still has a long way to go. We believe that safe blood is every patient’s right, and we are committed to it. The future though probably lies in synthetic blood which is still under R&D.